Telehealth after the pandemic: CMS outlines proposed changes

Psychologists who treat and assess patients via telehealth, including audio-only devices, should pay close attention to the 2022 Medicare physician fee schedule proposed rule, which outlines potential changes to health care services and reimbursement rates for all providers. If similar proposals are adopted by other third-party payers, all psychologists—not only those who work with Medicare—will be impacted.

In the proposed rule, the Centers for Medicare and Medicaid Services (CMS) revealed several changes that would affect how telehealth services are delivered when the COVID-19 public health emergency (PHE) ends. Patients will lose access to some psychological services if CMS does not continue to allow testing, Health Behavior Assessment and Intervention (HBAI), and adaptive behavior and treatment services to be furnished via telehealth after the PHE. Recent changes in federal law, however, do protect access to telehealth services for Medicare beneficiaries needing diagnoses, evaluation, or treatment for mental health disorders from their homes.

Members of the public have until September 13, 2021, to send comments and feedback on the proposed rule to CMS. Patients with mental and behavioral health problems have been the heaviest users of telehealth services during the PHE, and psychologists have done amazing work in meeting their needs. Your patients will need access to telehealth and audio-only services after the PHE, so you are strongly encouraged you to make your voice heard.

Act now and join thousands of you colleagues in advocating for psychology by submitting comments to CMS.

In addition to your individual comments, as an organization APA will submit comments to CMS advocating that the agency takes the following steps to preserve access:

APA will advocate for all telehealth services to continue to be paid at the same rate as in-person services once the PHE ends. Before the PHE, CMS paid for telehealth services at the facility rate, which is lower than the nonfacility rate paid for outpatient office visits. This table shows five services commonly billed by psychologists and the difference in facility vs. nonfacility reimbursement rates.

Reduced reimbursements for telehealth and audio-only services will impede telehealth expansion and restrict patient access. Because private payers and Medicaid programs look to Medicare as a benchmark, this could lead to lower reimbursement rates with other payers.

In 2020, CMS rejected APA’s request to add the multiple family group psychotherapy code (90849) to telehealth because it is a noncovered service in Medicare. APA will again advocate for CMS to adopt this code—even if Medicare will not reimburse for it. The adoption of this code by CMS would hopefully lead more private insurers to cover these services.

In 2020 APA asked CMS to add the codes for psychological and neuropsychological testing evaluation to its permanent telehealth list for feedback sessions, and the codes for testing administration to the temporary telehealth lists. Although our recommendation was not adopted, the agency has proposed allowing psychologists to offer telehealth testing services until the end of 2023. APA supports this proposal as it will give stakeholders more time to persuade the agency that these services are critical to the health of many patients and can be furnished via telehealth without reducing their effectiveness.

APA is also recommending that services for developmental testing and adaptive behavior and treatment be allowed to continue as telehealth until the end of 2023.

When the PHE ends, recent changes in federal law will require that patients receiving telehealth visits must have an in-person visit with the provider within six months of a telehealth visit. Psychologists and other mental health providers have been successfully doing remote visits with many patients since March 2020. Allowing patients to remain in their homes makes it easier for them to obtain services and reduces the risk of missed appointments.

APA will also ask CMS to allow audio-only access to more psychological services than just those for mental health disorders as directed under the Consolidated Appropriations Act 2020. Patients need access to audio-only HBAI services, testing evaluation services for feedback sessions, and neurobehavioral status exams.

APA supports billing audio-only services with a modifier to facilitate data collection but does not believe that additional documentation is necessary to justify the use of audio-only devices.

CMS has proposed allowing providers to offer telehealth, including audio-only services, to patients who receive services through Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), another idea that APA supports. Again, APA will advocate that CMS expand its proposal to include HBAI services for FQHC and RHC patients.

Faced with the need to meet budget neutrality requirements instituted by Congress, CMS has again proposed reducing the conversion factor (CF), the figure by which all code values are multiplied to achieve a payment amount for each service. For 2022, CMS has proposed cutting the CF by 3.89%, which would lead to significant payment losses for psychologists.

Congress stepped in last year to provide extra funding for Medicare and avert a serious cut in payment for all providers. Once again, APA will urge Congress to intervene to preserve patient access to critical mental and behavioral health services and alleviate the potential financial burden of being a Medicare provider. APA will encourage psychologists to send targeted messages to Congressional leaders on this issue after the CMS comment period closes on September 13, 2021, and more details will be forthcoming from APA’s Advocacy Office.

APA encourages all psychologists to submit individual regulatory comment letters through our advocacy platform, allowing us to track the number of comments submitted. APA has made it quick and easy to submit personalized comments directly to CMS with APA’s Action Center. This includes offering draft letters which you can copy, paste, and personalize by explaining how the proposed changes and rate reductions affect you, your work, and your community.

Submit your comment today

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